Recently hospital cleanliness has become a matter of reputation, especially since the federal government’s Hospital Compare Web site started posting institutions’ rates of health care–associated infections. Cleanliness is also becoming a bottom-line issue: in 2008 the federal Centers for Medicare and Medicaid Services ceased reimbursing hospitals for the treatment of any infections that those hospitals caused—a controversial carrot-and-stick venture that, according to new research, has successfully begun to lower infection rates.

Institutions also employ infection-control specialists, who track infections and investigate their causes. Yet when the problem is bacteria on surfaces, eliminating them depends on the building-services crews. “This is the level in the hospital hierarchy where you have the least investment, the least status and the least respect,” says Jan Patterson, president of the Society for Healthcare Epidemiology of America. Traditionally, medical centers regard janitors as disposable workers—hard to train because their first language may not be English and not worth training because they may not stay long in their jobs.

At N.Y.U. Langone in 2010, Phillips and his co-workers launched a pilot project that redefined those formerly disposable workers as critical partners in patient protection. Janitors, they realized, know better than anyone else which rails are touched most frequently and which handles are hardest to clean. The Langone “clean team” paired janitors with infection-control specialists and nurses in five acute care units to ensure that all high-touch surfaces were thoroughly sanitized. In its first six months the project scored so high on key measures—reducing the occurrence of C. diff infections and the consumption of last-resort antibiotics—that the hospital’s administration agreed to make the experiment routine procedure throughout the facility. It now employs enough clean teams to assign them to every acute care bed in the hospital.

This is an excellent thing to do, but it costs money. If you train these workers, you have to keep them. That means you have to pay them well–that is, not view them as disposable people. This is how disdain for workers can kill.

Just something to keep in mind the next time janitors strike to earn the extravagant sums of ten to fifteen dollars per hour.

This is further complicated by how more and more institutions are relying on outside janitorial staffing services rather than their own hired staff and thus have less control over the training and pay of the actual individual workers cleaning their buildings.

Ah, yes, the minimum wage contract worker – so easy to monitor quality there !! This study needs to be publicized within an inch of its life. Maybe if Joe Patient got the news, the situation would change. Unfortunately, this whole paradigm is solidly entrenched in the modern economy.

Here in BC they pulled a really shitty stunt along these lines – they took out the permanent, (reasonably well-paid and invested) janitorial staff from hospitals and replaced them with (the cheapest) contractors. It did not go well.

I wish managementcritters thought of this more often. Want to focus on the areas needed? Ask the people who clean them, dammit. (A while back, my partner’s company used this theory to plan for a conference. Turned out the biggest catering problem was… ants.)
And wow that price. Our gov’t hospitals pay about $1.5, at the current rate of exchange. International comparisons are funny.